Mobilization and Manipulation for Low-Back Pain

Mobilization and manipulation have been compared with placebo physiotherapy in patients with nonspecific back pain. Studies were conducted on 94 patients seen in general practice and 94 referred to hospital rheumatology and orthopaedic clinics for a specialist opinion. Assessments were performed immediately after the treatment course, two months later, and at one year. Most patients in both series showed improvements. In the general practitioner series, there was a slight but definite advantage in favor of those receiving mobilization and manipulation immediately after the course of treatment. However, these differences had largely disappeared at three months, and at one year the two groups were identifical. Analysis of the data indicated that clinical improvement correlated with the shorter length of history. No such advantage in favor of mobilization and manipulation was found in the hospital series. It is believed that this is because the hospital patients all had a longer duration of symptoms and a number of other features that were identified as being significantly worse. This study indicates the high rate of spontaneous resolution of low-back pain. In patients likely to improve anyway, mobilization and manipulation may hasten improvements but do not affect the long-term prognosis.